The Pathology of Cancer aint Monkeys Business

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The Pathology of Canceraint Monkeys Business
Daniel Savino
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The Pathology of Cancer

• 1-CANCER, the disease from the pathologists
  point of view
• 2-PATHOLOGY, the medical specialty

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The disease from the pathologists point of view

• Cancer (or any of its synonyms) is the generic
  name for a very HETEROGENOUS group of diseases
• Each cancer has its own name
• All named cancers can be placed in one of
  various classifications
• The most common classifications are based by the
  organ the cancer starts in, the kind of cell from
  which it is derived, as well the appearance of
  the cancer cells.

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All living creatures are made of cells
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They are the smallest unit of life they carry
all the functions that constitute the process
call life and they are capable of reproduction
producing 2 cells exactly identical to the mother
cell Their mass and size varies an average
animal cell is 20 micrometers
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(No Transcript)
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The power of The Microscope
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Exactly in this way we all started, as a single,
fragile cell
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went from 1 to 100 trillions cells
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When cell divides the 2 cells formed are not
always identical
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Differentiation variety of cell TYPES produced
(limited)
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Other cell types (connective
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Tissues Organs

• Similar of limited varied groups of cells
  TISSUES
• Combination of tissues for a common functional
  purpose ORGANS
• Organs organized into SYSTEMS

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Digestive System
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Cancer from a pathologists standpoint

• There is a disease process in the tissue sample
• The process has the morphologic features of a
  tumor
• The tumor is malignant
• The tumor is a CARCINOMA (made up of epithelial
  cells), or a SARCOMA (made up of connective
  tissue cells), etc

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The task of the pathologist,

• (when confronted with cancer in a tissue sample)
• to recognize the cancer by its name.
• it happens to all of us that, from time to time,
  we come across a cancer we DO NOT RECOGNIZE
• reason 1 it is a very rare one and we just do
  not remember it or, worse, we never got
  acquainted with it or,
• reason 2 the cancer is so uncooperative that
  looks like nothing else that has been described
  before
• those remain unnamed cancers we pathologists
  try to keep the number of this type of cancers
  VERY LOW.

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What is Pathology- a pathologist?

• Oxford English Dictionary
• patho- is a combining form that has its
  ORIGIN from Greek pathos that means suffering
  or disease or relating to disease.
• A combining form is to be combined, and by
  combining patho- with another combining form of
  Greek origin
• -logy (in Greek logos means word and from it
  derives -logia which is a body of words about a
  subject or study) we get the word pathology
  meaning something like the science or the study
  of diseases

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Morbid Anatomy or Histopathology
Examination of entire organs or (more common)
small fragments of organs that has been taking
out during an operation (BIOPSY), to
determine 1- whether there are changes in the
normal appearance (anatomy or microanatomy) of
that sample 2- what is the nature of those
changes (what is the disease)
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SOME pathologic TERMS you may come across and
not be sure of their meaning

• RE-EXAMINATION reasons realistic
  expectations sampling confirmation vs changes
• SECTIONS Frozen vs Permanent gross
  (Blocks) vs histologic additional vs
  step-level or deeper
• ARTIFACTS obvious vs subtle resolvable vs
  unsoluble insignificant vs significant
• All tinted by the SUBJECTIVE-Personality
  issues (of the pathologist)

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SOME pathologic TERMS you may come across and
not be sure of their meaning

• SPECIAL STAINS conventional (physico-chemical
  properties) vs IHC (immunologic) IHC diagnostic
  vs prognostic qualitative vs quantitative (is
  there a scoring system description)
• SPECIAL PROCEDURES Flow (or flow-cytometry) molec
  ular PCR, FISH, etc
• BLOCKS or PARAFFIN BLOCKS
• UNSTAINED SLIDES
• Fate of the samples

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• SPECIAL STAINS conventional (physico-chemical
  properties) vs IHC (immunologic) IHC diagnostic
  vs prognostic qualitative vs quantitative (is
  there a scoring system description)
• SPECIAL PROCEDURES Flow (or flow-cytometry) molec
  ular PCR, FISH, etc
• BLOCKS or PARAFFIN BLOCKS
• UNSTAINED SLIDES
• Fate of the samples

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SURGEON BIOPSYING SLN
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SPECIMENS ENTERED INTO THE PATHOLOGY SYSTEM
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PATHOLOGIC GROSS EXAM
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GROSS EXAM OF SPECIMEN
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SECTIONS PLACED IN CASSETTES FOR PROCESSING
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Placing small biopsies
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THE CASSETTE TISSUE DESIGNATION ENTERED IN
PATH SYSTEM
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The Sections are Processed Overnight
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NEXT MORNING-BLOCKING in PARAFFIN
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THIN SECTIONS OF TISSUE ARE OBTAINED
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SLIDES ARE ALMOST READY
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SLIDES ARE EXAMINED FOR DIAGNOSIS
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DICTATED PATH REPORT IS TRANSCRIBED
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Cancer, the disease

• For most of the history of humanity Cancer is
  there, incurable and fatal
• natural history XVIII century starts somehow,
  develops until first noticed, keeps growing and
  spreading, cause death of the host.
• Given its natural history, , it becomes relevant
  to try to determine (for multiple purposes) how
  far along it, a given cancer is, in given
  patient.

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So, Whats the Pathologists Job?

• To know histology
• To recognize abnormality
• To place it within database
• To render a Pathologic Diagnosis
• If CANCER, tell what
• Type
• Grade
• Stage
• do special studies when needed